Testing Eplerenone Treatment in Adults With Heart Attack or Injury Without Blocked Coronary Arteries Using Stratified Medicine

What this Trial Is About

Researchers are evaluating the use of eplerenone, a drug that blocks mineralocorticoid receptors, in patients who have had a heart attack or heart injury but do not have blocked large coronary arteries. The study focuses on patients with problems in small blood vessels in the heart, known as coronary microvascular dysfunction. The goal is to see if eplerenone can reduce heart damage and improve heart function in this group, as well as to better understand this condition using advanced tests and imaging. The trial includes a registry-based diagnostic study and a nested randomized, open-label, blinded-endpoint trial. Patients admitted with suspected heart attack undergo angiograms to assess small vessel function using a special guidewire. Those with coronary microvascular dysfunction measured by an index of microvascular resistance IMR 25 are randomly assigned to receive either eplerenone tablets, starting at 25 mg daily and increased to 50 mg after two weeks for six months, or standard care without eplerenone. Patients without microvascular dysfunction enter a registry for follow-up. Additional imaging including heart MRI and brain MRI substudies are performed. Participants will be closely monitored during hospital stays and through follow-up visits at one and six months, involving blood tests, heart MRI scans, and questionnaires assessing health status and quality of life. Long-term health outcomes such as hospitalizations and survival will be tracked via electronic records for up to 20 years. The main outcome measured is the change in heart injury biomarkers NT-proBNP over six months, alongside assessments of heart function, patient well-being, and other cardiovascular events.

Stratified Medicine of Eplerenone in Acute Myocardial Infarction or Injury and no Obstructive Coronary Arteries.